Clinical Features and Outcomes of Posterior Spinal Artery Infarction: A Systematic Review

Objective: We aim to describe the clinical features and outcomes of patients with posterior spinal artery infarctions, and to identify factors associated with poor ambulatory outcomes. Methods: We performed a systematic review and retrospective analysis on the characteristics and outcomes of patients with posterior spinal artery infarctions reported over the past 30 years. Results: We analyzed 40 cases from 33 studies between January 1993 till June 2023. Their median age was 55 years (range 19–84), with 23 males and 17 females. Cardiovascular risk factors were present in half (21/40, 53%). Pain (10/40, 48%) and motor deficits (27/39, 69%) were common Infarcts preferentially affected the cervical cord (29/40, 73%), and were frequently attributed to vertebral artery dissections (8/40, 20%) endovascular treatment complications (7/40, 18%)., However, the underlying cause remained unknown in a quarter (10/40, 25%). Treatment involved isolated or concomitant use of anticoagulants (8/28, 29%), antiplatelet (18/28, 64%), and steroids (5/28, 18%). Prognosis appeared fair as most could ambulate (28/34, 82%), but over a quarter could only do so with assistance (8/28, 29%). Patients who were older, (median age [range]: 67 [52–84] vs 56 [28–79], p  = 0.055), with preceding trauma (50% vs 11%, p  = 0.053), or with infarcts involving three or more cord segments (83 vs 33%, p  = 0.062) may be likelier to experience non-ambulatory outcomes. Conclusion: Though rare, posterior spinal artery infarctions’ propensity for disability renders their early recognition especially vital. Pain and preceding trauma or endovascular treatment are diagnostic clues. Old age, preceding trauma, and longer infarcts may be associated with non-ambulatory outcomes.